Effectiveness of myofascial release in treatment of chronic musculoskeletal pain: a systematic review.

OBJECTIVE: To evaluate the evidence on the effectiveness of myofascial release therapy to relieve chronic musculoskeletal pain and to improve joint mobility, functioning level, and quality of life in pain sufferers. Data sources and review: Randomized controlled trials were systematically gathered from CENTRAL, Medline, Embase, CINAHL, Scopus, and PEDro databases. The methodological quality of articles was assessed according to the Cochrane Collaboration's domain-based framework. In addition, the effect sizes of main outcomes were calculated based on reported means and variances at baseline and in follow-up. RESULTS: Of 513 identified records, 8 were relevant. Two trials focused on lateral epicondylitis ( N = 95), two on fibromyalgia ( N = 145), three on low back pain ( N = 152), and one on heel pain ( N = 65). The risk of bias was considered low in three and high in five trials. The duration of therapy was 30-90 minutes 4 to 24 times during 2-20 weeks. The effect sizes did not reach the minimal clinically important difference for pain and disability in the studies of low back pain or fibromyalgia. In another three studies with the high risk of bias, the level of minimal clinically important difference was reached up to two-month follow-up. CONCLUSION: Current evidence on myofascial release therapy is not sufficient to warrant this treatment in chronic musculoskeletal pain.

A study of the psychometric properties of 12-item World Health Organization Disability Assessment Schedule 2.0 in a large population of people with chronic musculoskeletal pain.

OBJECTIVE: To assess the validity of the Finnish translation of the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0). DESIGN: Cross-sectional cohort survey study. SETTING: Physical and Rehabilitation Medicine outpatient university clinic. SUBJECTS: The 501 consecutive patients with chronic musculoskeletal pain. MAIN MEASURES: Exploratory factor analysis and a graded response model using item response theory analysis were used to assess the constructs and discrimination ability of WHODAS 2.0. RESULTS: The exploratory factor analysis revealed two retained factors with eigenvalues 5.15 and 1.04. Discrimination ability of all items was high or perfect, varying from 1.2 to 2.5. The difficulty levels of seven out of 12 items were shifted towards the elevated disability level. As a result, the entire test characteristic curve showed a shift towards higher levels of disability, placing it at the point of disability level of +1 (where 0 indicates the average level of disability within the sample). CONCLUSIONS: The present data indicate that the Finnish translation of the 12-item WHODAS 2.0 is a valid instrument for measuring restrictions of activity and participation among patients with chronic musculoskeletal pain.

Psychometric properties of 12-item self-administered World Health Organization disability assessment schedule 2.0 (WHODAS 2.0) among general population and people with non-acute physical causes of disability - systematic review.

OBJECTIVE: WHODAS 2.0 is a unified scale to measuring disability across diseases, countries, and cultures. The objective was to explore the available evidence on the psychometric properties of 12-item self-administered WHODAS 2.0 among a general population and people with non-acute physical causes of disability. METHODS: Five databases Medline, Embase, Web of Science, Scopus, and PsycINFO were searched for papers related to the validity, reliability, responsiveness, minimal clinically important difference or minimal detectable change of 12-item self-administered WHODAS 2.0. In order to avoid missing any potentially relevant studies, the search clauses were left as generic as possible and the refining search was conducted manually. As the review was focusing on chronic physical disorders and general adult population, major psychiatric diagnoses, acute traumas, other acute conditions (e.g., postpartum or pregnancy), hearing loss, progressive neurological disorders, and age <19 years were excluded. The relevancy of the studies was assessed by two independent reviewers. RESULTS: The 14 out of 191 observational studies were considered relevant. The sample sizes varied from 80 up to 31,251 participants. Great diversity was observed in the participants' health problems. The Cronbach's alpha was high - up to 0.96. The correlations between WHODAS 2.0 and other disability scales were high. Substantial floor without ceiling effect was reported by two studies. Exploratory factor analysis resulted in a multidimensional structure - up to five factors. The discriminative ability and test-retest reliability of the scale was good. CONCLUSIONS: It seems, that the 12-item self-administered WHODAS 2.0 is internally consistent and a reliable scale demonstrating overall good correlation with other measures of disability. However, it appears that it is a multidimensional scale and its total score may represent different combinations of several contributing factors. Thus, the 12-item WHODAS 2.0 can be more reliable when creating a person's functional profile formed by the 12 individual item scores instead of a single total sum.IMPLICATIONS FOR REHABILITATIONThe 12-item self-administered WHODAS 2.0 is internally consistent and a reliable scale demonstrating overall good correlation with other measures of disability.It appears that it is a multidimensional scale and its total score may represent different combinations of several contributing factors.The 12-item WHODAS 2.0 can be more reliable when creating a person's functional profile formed by the 12 individual item scores instead of a single total sum.

Correlation between Oswestry disability index and 12-item self-administered version of World Health Organization Disability Assessment Schedule (WHODAS 2.0) in patients with chronic low back pain.

The objective of the study was to investigate the correlation between the 12-item WHO Disability Assessment Schedule (WHODAS 2.0) and the Oswestry disability index (ODI). Prospective cross-sectional study of 1379 patients (age 48 years) with chronic low back pain. The Spearman's rank correlation test was employed. Of all the possible 143 correlations, 46 (32%) were strong and nine (6%) were very strong. The strongest correlations ≥0.6 were seen for 'personal care' (ODI) vs. 'washing whole body' (WHODAS 2.0), 'personal care' (ODI) vs. 'getting dressed' (WHODAS 2.0), 'walking' (ODI) vs. 'walking long distances' (WHODAS 2.0) and 'social life' (ODI) vs. the WHODAS 2.0 total score. In conclusion, while items defining physical functioning were mostly strongly correlated, items defining social or psychological functioning were less associated. Both scales could be used together providing valuable information regarding the functioning of people with chronic low back pain.

Correlation between the pain numeric rating scale and the 12-item WHO Disability Assessment Schedule 2.0 in patients with musculoskeletal pain.

OBJECTIVE: The aim of this study was to assess the correlation between pain severity measured on a numeric rating scale and restrictions of functioning measured with the WHO Disability Assessment Schedule (WHODAS 2.0). PATIENTS AND METHODS: This was a cross-sectional study of 1207 patients with musculoskeletal pain conditions. Correlation was assessed using Spearman's and Pearson tests. RESULTS: Although all the Spearman's rank correlations between WHODAS 2.0 items and pain severity were statistically significant, they were mostly weak, with only a few moderate associations for 'S2 household responsibilities', 'S8 washing', 'S9 dressing', and 'S12 day-to-day work'. The correlation between the WHODAS 2.0 total score and pain severity was also moderate: 0.41 [95% confidence interval (CI): 0.36-0.45] for average pain and 0.42 (95% CI: 0.37-0.46) for worst pain. The correlation between the WHODAS 2.0 total score and pain level was also assessed using Pearson's product-moment correlation, yielding figures that were similar to Spearman's correlation: 0.42 (P<0.0001, 95% CI: 0.37-0.46) for average pain and 0.39 (P<0.0001, 95% CI: 0.34-0.44) for worst pain. CONCLUSION: Among patients with chronic musculoskeletal pain, the correlation between pain severity measured by numeric rating scale and functioning level measured by WHODAS 2.0 was weak to moderate, with slightly stronger associations in physical domains of functioning.

Psychometric properties of the Oswestry Disability Index.

The aim of this study was to investigate the psychometric properties of the Oswestry Disability Index (ODI) in a large cross-sectional cohort of individuals with chronic low back pain by defining its internal consistency, construct structure and validity, and its ability to differentiate between different degrees of functional limitation. A total of 837 consecutive outpatient patients with low back pain were studied. The internal consistency of ODI was assessed by Cronbach's α, construct structure by exploratory factor analysis, construct validity by confirmatory factor analysis, and discrimination was determined by item response theory analysis. The ODI showed good internal consistency (α=0.85). Explanatory factor analysis showed that ODI is a unidimensional test measuring functional level and nothing else. The confirmatory factor analysis showed that the standardized regression weights of all ODI items were relatively high, varying from 0.5 to 0.7. The item response theory analysis suggested that eight out of 10 ODI items have a close to perfect ability to measure functional limitations in accordance with the actual severity of disability experienced by the respondents. Discrimination of all the items was high to perfect (1.08-2.01). The test characteristic and test information curves showed that the discriminative ability of the ODI is superior at higher levels of disability. The present data showed that the ODI is an internally consistent, unidimensional scale with overall excellent construct validity and ability to discriminate the severity of functional disability. The analysis suggests that the ODI may better distinguish between the relative degrees of function at above-average disability levels.

Progressive resistance training in Parkinson's disease: a systematic review and meta-analysis.

OBJECTIVES: To investigate if there is evidence on effectiveness of progressive resistance training in rehabilitation of Parkinson disease. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Central, Medline, Embase, Cinahl, Web of Science, Pedro until May 2014. Randomised controlled or controlled clinical trials. The methodological quality of studies was assessed according to the Cochrane Collaboration's domain-based evaluation framework. DATA SYNTHESIS: random effects meta-analysis with test for heterogeneity using the I² and pooled estimate as the raw mean difference. PARTICIPANTS: Adults with primary/idiopathic Parkinson's disease of any severity, excluding other concurrent neurological condition. INTERVENTIONS: Progressive resistance training defined as training consisting of a small number of repetitions until fatigue, allowing sufficient rest between exercises for recovery, and increasing the resistance as the ability to generate force improves. COMPARISON: Progressive resistance training versus no treatment, placebo or other treatment in randomised controlled or controlled clinical trials. PRIMARY AND SECONDARY OUTCOME MEASURES: Any outcome. RESULTS: Of 516 records, 12 were considered relevant. Nine of them had low risk of bias. All studies were randomised controlled trials conducted on small samples with none or 1 month follow-up after the end of intervention. Of them, six were included in quantitative analysis. Pooled effect sizes of meta-analyses on fast and comfortable walking speed, the 6 min walking test, Timed Up and Go test and maximal oxygen consumption were below the level of minimal clinical significance. CONCLUSIONS: There is so far no evidence on the superiority of progressive resistance training compared with other physical training to support the use of this technique in rehabilitation of Parkinson's disease. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO 2014:CRD42014009844.

Do aerobic exercises really improve aerobic capacity of stroke survivors? A systematic review and meta-analysis.

BACKGROUND: Even if aerobic exercises are recommended to stroke survivors, the clinical significance of the effect of these exercises on aerobic capacity has not been definitely shown. AIM: To investigate, if there is evidence that aerobic capacity, measured by maximal oxygen consumption, can be improved by aerobic training? DESIGN: Systematic review and meta-analysis, all settings. SETTING: Department of Physical and Rehabilitation Medicine of a University Hospital. POPULATION: Adult stroke survivors. METHODS: Search on CENTRAL, MEDLINE, EMBASE, CINAHL, Pedro. Study selection and extraction based on the Cochrane Handbook for Systematic Reviews. Random effects meta-analysis. RESULTS: Based on 13 randomized aerobic training improved aerobic capacity on average by 2.5 mL/kg/min. Four of the included studies had low risk of bias. CONCLUSIONS: There is strong evidence that aerobic training is capable of improving aerobic capacity of stroke survivors, supporting the routine recommendation for training after stroke. CLINICAL REHABILITATION IMPACT: It is not known, if one type of training is more effective than others in stroke survivors.

Differences between rehabilitation team, rehabilitants, and significant others in opinions on functioning of subacute stroke survivors: Turku ICF study.

To assess quantitative differences between rehabilitation team, rehabilitants, and significant others in opinions on functioning of subacute stroke survivors. During inpatient interdisciplinary neurorehabilitation, the interdisciplinary team, nurses, rehabilitants, and significant others reported their opinions on the functioning of consecutive 62 rehabilitants. Data were gathered using the structured form based on the International Classification of Functioning, Disability and Health (ICF) Brief Core Set for Stroke. Agreement between observers on the presence and severity of restrictions in functioning was analyzed. The strongest agreement between different observers on all studied ICF categories was achieved between the interdisciplinary team and nurses (weighted squared κ=0.7-0.9). The weakest agreement was detected between the team and rehabilitants (weighted squared κ=0.1-0.6). Support by family was found to be an important facilitating factor of functioning by all observers. Limitations in cognitive activity were identified less frequently than other restrictions. Opinions on restrictions in functioning may differ between the interdisciplinary team, rehabilitants, and significant others. These differences can be assessed quantitatively and documented using the ICF Core Set for Stroke. This potential observer-dependent discrepancy should be taken into account during the process of neurorehabilitation.